As the COVID-19 public health emergency expires in the United States, many of the data streams that have helped Americans monitor the virus will go dark. However, experts can use sewage to keep tabs on the virus. People infected with the virus shed the pathogen in their stool, whether or not they take a COVID test or seek medical care, enabling officials to track levels of the virus in communities over time and to watch for the emergence of new variants. The National Wastewater Surveillance System, which the CDC established in late 2020, now includes data from more than 1,400 sampling sites, distributed across 50 states, three territories, and 12 tribal communities, covering over 138 million people. Houston has an extensive wastewater surveillance infrastructure, collecting samples weekly from 39 of the city’s wastewater treatment plants, as well as from individual schools, shelters, nursing homes, and jails. However, wastewater surveillance is still missing many communities, and more work is needed to turn what began as an emergency effort into a sustainable national system. Further, officials will need to be thoughtful about how they use the data as the pandemic continues to evolve. As clinical testing drops off, wastewater surveillance will also be a key strategy for keeping tabs on new variants and for gauging the threat they pose. Finally, proponents of wastewater surveillance are hoping to demonstrate its continued utility, both for COVID-19 and other diseases, with some jurisdictions already using wastewater to track influenza and other pathogens.
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